title: Intramural injection with botulinum toxin significantly elongates the pig esophagus.
abstract: OBJECTIVE
  Surgical treatment of long-gap esophageal atresia (LGEA) is challenging. Methods which facilitate stretching of the esophageal pouches may allow primary anastomosis. Botulinum toxin type A (BTX-A) blocks acetylcholine release in neuromuscular junctions, thereby causing muscle relaxation. We hypothesized that intramural injections with BTX-A into the esophageal wall of piglets would significantly elongate the tissue upon stretch.
  
  
  METHODS
  Twenty-four piglets were randomized to receive BTX-A of placebo (saline). After one hour, the esophagus was removed en bloc and tested in a stretch-tension device.
  
  
  RESULTS
  The mean esophageal elongation was 84% (range 83-101) in the BTX-A-group and 65% (50-78) in the control group. The mean difference between the two groups was 18%, which was significant (p < 0.001).
  
  
  CONCLUSIONS
  Intramural injections with botulinum toxin type A elongate the esophagus significantly. Clinically, this could be a potential method to achieve primary anastomosis in LGEA. Additional clinical studies are necessary to evaluate the method before it can be generally recommended.
authors.affiliation: Surgical Department A, Odense University Hospital, Denmark.
authors.forename: Heidi Fhær
authors.initials: HF
authors.lastname: Larsen
authors.forename: Thorbjørn Søren Rønn
authors.initials: TS
authors.lastname: Jensen
authors.forename: Lars
authors.initials: L
authors.lastname: Rasmussen
authors.forename: Mark
authors.initials: M
authors.lastname: Ellebæk
authors.forename: Niels
authors.initials: N
authors.lastname: Qvist
mesh_terms: D000109:Acetylcholine / Q000378:metabolism; D000818:Animals; D015415:Biomarkers / Q000378:metabolism; D001696:Biomechanical Phenomena; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000494:pharmacology*; D004947:Esophagus / Q000187:drug effects* / Q000378:metabolism / Q000601:surgery; D007267:Injections; D016014:Linear Models; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000494:pharmacology*; D011897:Random Allocation; D013552:Swine; D013718:Tensile Strength
chemical_list: D015415:Biomarkers; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; D000109:Acetylcholine
keywords: Acetylcholine; Botulinum toxin type A; Long gap esophageal atresia; Pigs; Synaptophysin